The clinical features and aetiology of 100 consecutive symptomatic heterosexual male patients with urethritis were studied from March 1994 to August 1994 in the Genito-Urinary Medicine (GUM) Clinic, Kuala Lumpur Hospital. Gonococcal urethritis (GU) was found to be more common (53%) than non-gonococcal urethritis(47%). All patients with GU confirmed microbiologically had clinically evident urethral discharge. Almost half (41%) of the patients with GU developed post-gonococcal urethritis (PGU). The most common organism isolated in PGU was Ureaplasma urealyticum (37%) whilst only 4% had both Chlamydia trachomatis and Ureaplasma urealyticum. Of the 47% of patients with non-gonococcal urethritis (NGU), 50% had no microorganism isolated, 32% had Ureaplasma urealyticum, 7% Chlamydia trachomatis and 11% both Chlamydia trachomatis and Ureaplasma urealyticum.
Study site: Genito-Urinary Medicine (GUM) Clinic, Hospital Kuala Lumpur
One hundred and eight consecutive previously untreated males with gonococcal urethritis were treated with single-dose oral ampicillin under supervision. A high failure-rate of 41.5 percent was obtained. The main cause of failure was the high incidence of penicillinase-producing Neisseria gonorrhoeae - an overall incidence of 37.2 percent was obtained.
One hundred and thirty-eight male patients presented unth. a total of 146 episodes of urethritis at a Kuala Lumpur STD clinic over a period of six months. Gonorrhoea accounted for almost 4 out of 5 cases of male urethritis. The incidence of betalactamase producing strains of Neisseria gonorrhoeae was 36 percent. Furthermore nearly 3 out of 10 cases of gonococcal urethritis developed post-gonococcal urethritis.
Penicilliosis is a systemic fungal infection caused by Penicillium marneffei. The infection is most commonly seen in Southeast Asia, Southern China, Hong Kong, and Taiwan. It is rarely seen among individuals of African descent. Here, we report a case of penicilliosis in an African man from Namibia who was studying in Malaysia. He presented with multiple umbilicated papules associated with cough, fever, loss of appetite, and weight. He also had urethral discharge and admitted to unprotected sexual intercourse with multiple partners. Histopathological examination of a skin papule showed the presence of multiple 2 to 4 microm intracellular yeast cells. Culture of the papule revealed Penicillium marneffei. The serology for human immunodeficiency virus (HIV) was positive. This case illustrates the need to recognize penicilliosis in any individuals staying or travelling to Southeast Asia and the need to look for underlying HIV infection in adults with umbilicated papules.
Despite being part of one of the few remaining primitive areas of the world, both Sabah and Sarawak are provided with adequate, though simple, urban and rural general medical services. At present no reliable data on the incidence of sexually transmitted diseases in these areas have been collected and no organised treatment services are available. Gonorrhoea appears to be the commonest notifiable infectious disease in Sarawak, and beta-lactamase-producing strains have been isolated. Because of the rapidly expanding economy and the encouragement of the tourist trade, sexually transmitted disease is likely to prove an increasing problem, for which a specialised service for diagnosis and treatment is badly needed.
A consecutive series of 56 male patients with uncomplicated gonococcal urethritis were treated with 2 gm of kanamycin intramuscularly. Twenty (35.7 per cent) specimens of gonococcus were PPNG, while 36 (64.3 per cent) were non-PPNG. An overall failure rate of 12.2 per cent was observed. Further breakdown showed failure rate of 20 per cent with PPNG and 7.7 per cent with non PPNG.
Forty-two previously untreated male patients with uncomplicated gonococcal urethritis were treated with a single dose oral regimen comprising 3 gm ofamoxycillin and 125 mg of clavulanic acid. Thirty-five patients returned for follow-up and the cure rate among them was 89 percent. The cure rate for patients infected with penicillinase producing Neisseria gonorrhoeae (PPNG) was 73 percent. Further work is required to establish the optimum dosage for this particular regimen.
Study site: Sexually Transmitted Diseases (STD) clinic at the Faculty of Medicine,
Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
First-void urine samples collected from sexually transmitted diseases (STD) clinic patients were examined by a nested polymerase chain reaction (PCR) and a commercial enzyme immunoassay (IDEIA Chlamydia) for the diagnosis of Chlamydia trachomatis urethritis or cervicitis. The primers for the PCR amplified a target in the major outer membrane protein (MOMP) gene in C trachomatis while the IDEIA detected genus-specific chlamydial lipopolysaccharide. Discrepant results were resolved by retesting urine specimens with a second (plasmid-based) PCR and taking urethral or endocervical swab results into consideration. For 231 men (chlamydial prevalence 20.4%), the sensitivity, specificity, positive and negative predictive values were 59.6%, 99.5%, 96.6% and 90.6% for urine IDEIA, 68.1%, 99.5%, 97% and 92.4% for urethral swab IDEIA and 97.9%, 99.5%, 97.9% and 99.5% for urine PCR. The corresponding rates for 66 women (chlamydial prevalence 54.6%) were 19.4%, 100%, 100% and 50.8% for urine IDEIA, 86.1%, 96.7%, 96.9% and 85.3% for endocervical swab IDEIA and 91.7%, 93.3%, 94.3% and 90.3% for urine PCR. Hence, in a high prevalence population, the urine IDEIA was a suitable alternative to the male urethral swab IDEIA but significantly less sensitive than the endocervical swab IDEIA. The urine PCR was, however, much more sensitive than the urine IDEIA for both men and women and could replace the endocervical swab IDEIA for the diagnosis of chlamydial cervicitis.
Sixty patients with uncomplicated gonococcal urethritis were treated with a single dose oral regime comprising 3 g of cefaclor and 1 g of probenecid. Forty-eight patients (80%) returned for follow-up and the overall cure rate among them was 91.6%. Among the isolates, 25 (41.7%) showed penicillinase producing Neisseria gonorrhoeae (PPNG) strains. The cure rate for patients infected with PPNG was 85% while the cure rate for non-PPNG was 96.4%. Further work is required to establish the optimum dosage for this particular regimen.
Four hundred and thirty five (435) cases 0f sexually transmitted infections (STIs) were notified from 20 (twenty) primary care clinics throughout Malaysia from June 1999 till September 2000 using the syndromic approach of STI management, adapted by the Ministry of Health based upon the criteria set by the World Health Organisation (WHO). Gonorrhoea was the most prevalent STI reported (30.34 %), followed by candidiasis (28.05%), syphilis (15.17%) and non-specific urethritis (NSU) — 14.02%) . As seen in most other parts of the world, the younger age groups (those between twenty and thirty nine years old) were found to be more commonly infected with STIs. Initial analysis shows that systematic data collection based on the syndromes and clear—case definitions (algorithms for the syndromic approach} need to be developed and added further to the current manual that is being developed for the health and medical staff at the operational it level. Exploration and expansion of behavioural surveillance research, management information systems of the syndromic approach, and development of new or additional strategies in the manual for the staff too, also need improvement. The Ministry of Health is also concerned about the quantity and quality of the available data based upon syndromic management of STI as compared to laboratory based criteria. Since this programme is very much client centered, the adoption of this approach generally might offer substantial improvements in the quality and effectiveness of STI care, either within the public or the private health care settings in Malaysia.